What should I expect from Meds?

[WestieHighlander]

Hi there. So I've recently been diagnosed (innatentive). I've been started on 20mgs of Vyvanse. So far, I'd say I've noticed 3 distinct "phases". 1) I feel quite calm and content when it kicks in. My concentration is generally good and I feel like I'm not bothered by outside "noise" much. This lasts a couple of hours after it kicks in.

2) The content and calm feeling starts to go away. But I still feel like my concentration is better than normal for a couple of hours.

3) I can definitely tell it's starting to wear off, and I feel much more "scattered" than when I take took the Vyvanse, both in terms of thoughts and concentration.

I understand my dose is going to be increased next Wednesday.

My question is this: is it "phases one" I'm aiming for ? Where I feel content and calm? Or is this short term and it's phase two that is really what the meds are for? The improved concentration, but not the better mood and calmness?

Also, I take the Vyvanse at about 9am, but it definitely wears off by about 3pm. I'm a father and husband, so would probably really benefit from the medication being "active" when I get home from work at about 6pm. How do people overcome this? Should I be taking it later than 9am?

Many thanks.

[STEM_Dad]

You can talk to your doctor about a booster dose to help you in the later afternoon and evening, such as a low dose Instant Release medication.

* (Note: according to what I've read about Vyvanse, it's only available as an extended release medication. An IR medication would have to be a different formulation, such as Adderall.)

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The only stimulant medication that I've taken for ADHD was Adderall XR. While not the same as Vyvanse, it should be similar enough for comparison. I was only prescribed Adderall for the first few months after my ADHD diagnosis. (I've been on non-stimulant atomoxetine since then.)

I wouldn't say that I felt "calm", but I do recall generally feeling good and definitely feeling a sense of relief. For me, it lasted about 8-9 hours, before my ADHD symptoms crept back. I also developed a bit of irritability in the evenings, after the Adderall wore off (similar to how I sometimes get when I'm overly tired). For me, the change to a medication that works 24x7 was helpful, but the main reasons for the change were that: 1. I developed a concerning side effect (tachycardia), and 2. the Adderall wasn't treating my ADHD symptoms well enough. (For me, atomoxetine has been twice as effective.)

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However, here's what I've learned from other ADHDers on forums like this, I recall reading about the experience that many people have had with stimulant ADHD medication. To the best of my recollection, experiences can vary like such:

• some people never experience that sense of calm (or what I felt as a "sense of relief")

• some people only experience it when starting a stimulant medication for the first time, and then not again

• some people experience it each time they start a stimulant medication, but it goes away after a few weeks or months, but comes back when they start a different medication...and so on (going back on a medication after a different one for a while might bring back that sensation)

• some continue to experience it, but only for the first part of the day (as you do)

• some feel that sense of calmness as long as the medication is active in their system

... Again, this is a consolidation of what I recall of a number of people's shared anecdotes of their experience with stimulant ADHD medication (amphetamine types for some people, methylphenidate types for others, some people had similar experience with both types).

[WestieHighlander in reply to STEM_Dad]

Thanks so much for replying. That's all useful info to a beginner. I'll have to see how I go.

[sooshi2 in reply to STEM_Dad]

Thanks for the info. I am seeing warnings on use of Atomoxetine that it could cause suicidal thoughts. Have you experienced that? Thanks for your thoughts on this.

[STEM_Dad in reply to sooshi2]

I haven't had any such issues. I don't recall having experienced suicidal thought ever in my life.

I know it's also a warning on antidepressant medications, such as SSRIs (selective serotonin reuptake inhibitor medications), which seems very paradoxical.

Atomoxetine is primarily an SNRI (selective norepinephrine reuptake inhibitor), but studies have found it also to work as a mild SSRI. Sometimes it is described as an SSNRI (selective serotonin and norepinephrine reuptake inhibitor).

The warning exists because the medication has been reported to cause that side effect in some patients.

I remember hearing a doctor say that it is a rare side effect for SSRIs, but they have to warn patients, because it is a particularly concerning side effect.

[sooshi2 in reply to STEM_Dad]

Thank you for your quick and thorough response. What I read did have the warning aimed at children and teenagers, but I am concerned that it might apply to adults also.

[WestieHighlander in reply to sooshi2]

Hi Sooshi. I'm actually also on an SNRI (duloxetine), as I was diagnosed (probably incorrectly as it turns out) with depression many years ago. I didn't have any suicidal ideation. However, when I was first started on Zoloft, SSRI, I DID have some for a couple of days. I think it's mainly an issue when you're younger and starting for the first time. But definitely something to be aware of.

[STEM_Dad in reply to sooshi2]

There's nothing wrong with being concerned. I think the warning exists for adults, as well as children and teenagers.

I know that for youths, brain formation is a continuous process (with lasts up to about 25). So, if you are in your mid-20s or younger, there might be more reason for this concern.

Still, I'm certain that the risk is statistically low, or else SSRI and SNRI medications would not be an option for younger people.

• Children's neurology changes fastest from birth until about 5 years old. (I think this is why ADHD meds aren't recommended for children under age 6.)

• Hormone changes beginning in adolescence can cause rapid and major changes in neurology, too. It's not just physical and social changes that teenagers go through. Their brains essentially rewire themselves. Thus, teens' responses to medication can be drastic, too.

• I believe these neurological changes slow down from late teens onward (but that's just my own observation).

[Wasted71years]

Hi WestieHighlander

I am still going through the titration process to optimize medication, but I did start on Vyvanse 20mg just as you did. Indeed the quietness was the first thing I experienced, plus improvement of my emotional disregulation.

However, that is generally a very low dose, often the starting dose is 30mg based on what I have read. Since I was 72 my physician was probably being cautious as we verified that the side effects didn't cause problems or elevate my blood pressure too much.

What the 20mg did not do is help with initiating tasks without having to be at a deadline and it did not seem to help me stick to activities to the finish. I think the best way to evaluation how each dose change or medication works for you is to work out what are the most important impacts of ADHD that you hope the medication will relieve. Then, assess each level you try against that.

I found that as I worked up to 30mg and now 40mg, the experience changes. The first few days or that first week my body has to adjust to the side effects, in my case the paradox that my mind is relaxed but I feel a bit of jitteriness in my body and might be very slightly irritable, but those negatives do go away for me for the rest of the month.

The sense of almost sleepiness that I felt initially with the 20mg is not a pronounced feature any more. I do find my mind is relaxed but it is a more subtle sensation than the what I experienced those first few weeks.

My personal priorities for medication are to help me avoid starting but not finishing a zillion projects and to be able to start tasks at appropriate times like neurotypical people are able to do. Secondarily the emotional outbursts, the flash of anger for just a minute, are an issue I want to fix by getting that extra bit of time to achieve a more balanced and reasonable response to frustration.

At this point, at 40mg, I am starting to benefit in the task initiation and completion. At 30mg it was a hint or hard to verify it wasn't coincidence, but at 40mg it is undeniably helping. I hope I can strengthen this further with my step up to 50mg which I anticipate after my doctors visit next week.

Side effects after the first few days of a step up are essentially zero. I can sense slightly effect on muscles, very slight, but nothing that is bothersome. There is only a slight reduction in appetite, while the impulsive snacking is quite well damped down. No other issues at all.

In the pursuit of assistance with that ADHD symptoms I most want to overcome, I could tolerate a reasonable amount of side effects, but for me so far there is no such 'side effect tax'. I get to sleep well, probably sleep better than when not supported by Vyvanse.

I am thankful for the gentle onset and dropoff of Vyvanse. I typically take it at 6AM when I get up, then take care of chores during that hour it is building up. The fadeout is very gradual for me but by the evening the benefits are mostly gone. I subjectively benefit from it for about 11 hours before it is too faded to assist. I am lucky, this is a good fit for me so far.

What I do as it fades out is to have my first caffeine of the day. I used to consume 120 ounces of diet coke plus a few coffees every day (self medicating as I understand it) but now may have only 12 ounces late in the day or one coffee. I do this if I need a bit of oomph to substitute for the medication's help, although caffeine is clearly not helping in most of the ways that proper medication will. I also schedule what I need to work on or important things so that they fall within my active window not at night.

Everyone's reactions, best medication and doses are different. I hope you have a successful path to find what gives you the most support possible.

[WestieHighlander in reply to Wasted71years]

Great explanation and very in keeping with my experience.